Is Your Medical Credentialing Taking Too Long?

Medical credentialing is an in-depth and meticulous process. The standards set forth by regulatory bodies like the National Committee for Quality Assurance (NCQA) require preliminary and ongoing review of a healthcare provider’s qualifications. These include, but are not limited to, prior training, licenses, education, background, residency, and any history of malpractice.

Not only does the NCQA require this credentialing for doctors, it also certifies credential verification organizations (CVOs) like Advantum Health’s credentialing subsidiary MedAdvantage to make sure they stay on top of all the compliance regulations. That’s why for most organizations, there are way too many details to effectively credential in-house unless you have a specialized team dedicated to it.

The cons of medical credentialing in-house

Healthcare credentialing is an ongoing process. Not only are you mandated to do it for every new hire, you must continue credentialing even after the healthcare provider starts working. Licenses expire, continuing education gets overlooked, and life happens. This creates a logistical nightmare if you don’t have a streamlined process. Hiring a dedicated staff also contributes a huge amount of overhead to your expenses.

Advantum Health’s subsidiary MedAdvantage eliminates the hassle of ongoing credential verification in a few ways. Their proprietary database streamlines the credentialing process by cross-referencing your current hire’s qualifications against primary source databases. It even notifies you if a license is expiring or requires additional certification. By automating manual tasks that are tedious to humans, not only do you eliminate costly errors, but you expedite credentialing turnaround significantly.

A faster way to credential

The risk of medical credentialing in-house versus outsourcing is too high to ignore. Malpractice suits and pending claims will raise your insurance rates. The simple miscommunication or oversight of a new update to primary source databases can put you at legal risk of non-compliance. Not to mention the human factor of putting your patients at risk by hiring an inadequate healthcare provider. The deck is stacked against in-house credentialing.

The biggest reason to outsource medical credential verification is the time factor: Humans simply take too long to credential without the help of software to automate the manual stuff. Taking into consideration that time is money, outsourcing credentials verification reduces the total cost of credentialing overall.

Unlimited scalability

Picture this. You have a team of people handling your credentialing requirements in-house and they are struggling to keep up with all the physicians on staff. A new expansion to the physician team tips the scales and it’s more credentialing than the department can handle. Now, the training involved in expanding the credentialing department requires specialized certifications creating a conundrum.

Credentialing software would have prevented this. When the majority of the time-consuming tasks run automatically it allows much more room to scale. You never have to worry about capping your scalability if you’re hiring more health care providers. This spreads the ratio of credentialing specialists you need to maintain in-house, and in many cases can be completely outsourced to a CVO.

For mid-size and large-scale health organizations, it’s cheaper, faster, and more accurate to outsource credential verification to a CVO rather than try and maintain the task in-house. Risk is mitigated, overall cost goes down, and time is saved.